President Barack Obama’s new health-care law didn’t intend to leave out folks such as
60-year-old Collins “Linnie” Haynesworth Jr., an unemployed printer.

But as it stands, Haynesworth, of Columbus, will be among an estimated 363,000 poor, uninsured
Ohioans who will fall into a coverage gap on Jan. 1 when the Affordable Care Act requires most
Americans to have health insurance or pay a penalty.

They don’t earn enough to qualify for federal income-tax credits to help buy private coverage
through Ohio’s new online marketplace, and they earn too much to be eligible for tax-funded
Medicaid.

“If the state doesn’t expand Medicaid coverage, they just aren’t going to have anything,” said
Dee Mahan, director of Medicaid Advocacy for Families USA, a liberal group.

When the state’s health exchange opens on Tuesday, more than 900,000 uninsured Ohioans who earn
between

100 percent and 400 percent of the federal poverty level will qualify for tax credits to lower
the cost of insurance. But those with lower annual incomes — less than $11,500 a year — will get no
help unless they currently qualify for Medicaid.

Whether eligibility is expanded to cover the state’s poorest uninsured could be decided in the
coming weeks by Republican leaders in the General Assembly.

Gov. John Kasich is pushing Medicaid expansion and could do so without legislative approval. For
now, he’s waiting on lawmakers who, so far, have rejected the plan. Conservatives argue it’s costly
and spends money the government doesn’t have and question why those who would gain health coverage
aren’t working.

“This is mostly a population of able-bodied adults, 95 percent of whom don’t have dependent
children, and they aren’t even working a full-time, federally minimum-wage job,” said Edmund
Haislmaier, a senior fellow for health policy at the Heritage Foundation, a conservative research
group in Washington.

He suggests that states provide limited health insurance for only primary care to those in the
coverage gap, tying benefits to work requirements, as the welfare program does.

Haynesworth, the out-of-work printer, said that’s not fair.

“They think everyone is lazy or they are trying to scam the system. There are people like that
but not nearly as many as they think,” he said. “I know there are people who can’t afford
insurance, even if it’s just $10 a month.”

Haynesworth had worked in the printing business for more than four decades when he lost his job
in June 2010. He gets occasional freelance work, but with his unemployment benefits and savings
exhausted, he can’t pay his mortgage and relies on help from family and friends.

He has no health insurance, but his longtime doctor continues to treat him for high blood
pressure, and a hospital-assistance program paid a good portion of his medical bills from emergency
back surgery.

“The only reason I went to the doctor was because the pain was so excruciating and I couldn’t
stand it anymore,” Haynesworth said.

“I told them I didn’t have insurance and no money and there was no way I could pay, and they
said, ‘You have to have it.’ I filled out some paperwork (for assistance), but I still get bills
for all kinds of things.”

The coverage gap was created last year when the U.S. Supreme Court upheld the insurance mandate
and other parts of the health-care law but ruled that states could not be forced to expand their
Medicaid programs.

Since then, 25 states and the District of Columbia have agreed to expand Medicaid eligibility,
and 22 states have declined.

Ohio, New Hampshire and Tennessee are the only states still debating the issue, according to the
Kaiser Family Foundation.

As proposed, Medicaid would be expanded to Ohioans earning as much as 138 percent of the federal
poverty level, or roughly $15,400 a year. Although Kasich says he opposes Obamacare, he argues that
Medicaid expansion is a good deal for Ohio taxpayers and the uninsured.

The federal government will pay 100 percent of expansion costs for three years beginning on Jan.
1 and more than 90 percent after that, bringing $13 billion to the state over the next seven
years.

Ohio Medicaid Director John McCarthy said those gaining coverage would be adults younger than 64
who do not have children younger than 18 living at home. (Medicaid already covers children, most
parents and the disabled at this income level.)

About half report earned income, so they have a job, likely low-wage or part-time work with no
health-care benefits or none they can afford, McCarthy said.